Archive for the ‘Medicine’ category

With age, one sometimes begins to accumulate wisdom, and, although I am not one to focus on the woulda, shoulda, coulda opportunities that have passed me by, one regret that I surely have is that I had not met Dr. David Rakel until about three years ago. Dr. Rakel is the Director of the University of Wisconsin Integrative Medicine program. He attended medical school at Baylor in Houston, Texas, and completed a family practice residency in Greeley, Colorado. He is a doctor, a father, an academician, but most importantly, he is a healer. Of all of the physicians that I have ever known – and there have literally been hundreds of them, Dr. Rakel embraces all that is good in the medical profession.

David P. Rakel, MD

In his presentation, “Placebo or NoCebo,” David outlined the ingredients present in a healing environment: 1. A relationship with a helping person, 2. A healing setting, 3. An explanation that gives a sense of control of a symptom. 4. A ritual procedure or plan that involves active participation of both parties – patient and clinician – that results in belief towards action. He spoke passionately about the importance of touch, the intrinsic value of healing, and the fact that something was done with the ritual. One of my favorite, tongue- in- cheek quotes that David had was from Voltaire: “ It is the physician’s duty to amuse the patient while nature cures the disease.”

Dr. Rakel talked about the intelligence of being positive while giving the prognosis, showing empathy, empowering the patient, and demonstrating the importance of having a connection between the physician and patient. I’m sure that I’m not capturing all of the salient points that David carefully made, but I am sure that I understood his commitment to connection with the patient and the significance of using as many positive words as possible to convey that connection.

Once again, a great quote from Dr. Rakel revolved around the fact that you get better faster if you have unconditional love from your pet than a bad connection with your doc. He and his research on the common cold both suggested that, “It is better to stay home and be licked by your dog, than to spend time at a clinic with a grumpy doc!”

His recommendations to his residents and to all of the physicians to whom he lectures is that the physician needs to display empathy, compassion, patience and the ability to listen. His counsel to meditate revolved around the need for us to get out of our chaos and influence self-healing mechanisms. He described this journey from awareness to awakening to authenticity and finally to awe where the closer that we get to authenticity, the more beautiful our lives become.

Dr. Rakel then launched into numerous studies that evolved around the placebo effect such as the study where arthroscopic knee surgeries were “faked,” but resulted in positive outcomes. By referring to obesity as working toward optimal weight; chronic pain as myofascial health, depression (and this is my favorite) as potentially happy, the patients are not labeled with negative implications, and we accomplish a shift in our intentions. Not unlike what Newton, Einstein and Stephen Hawkins have done in physics, perceptions have been shifted by changing the manner in which we observe things. He said, “How about if we tell the patient that they are potentially happy rather than clinically depressed?” Our intention is reflective of our future.

Finally, Dr. Rakel suggested that physicians protect time in their schedules, create space, create positive patient expectations, be fully present and listen to the patient, that they offer support and collaboration and create a plan by using words that heal rather than words that harm.

I’m speaking at the American Board of Integrative Holistic Medicine’s Educational Conference today at 2:00 PM, but have been listening intently to the various presenters — my fellow board members, throughout the event. All of these folks are MD’s who embrace holistic (body, mind and spirit) and integrative (the world’s greatest) treatment modalities for appropriate care in medicine.

I’ve learned about Abraham Flexner who wrote a white paper in 1910 that became the de facto guideline for what would be taught in medical schools; essentially, a reductionist approach to practicing medicine which has led to the modern formula of medical practice, where the physician asks, “What’s your chief complaint.” Then he or she treats that — many times as if it were a stand-alone, unconnected condition, unrelated to any other causal factors.

This type of practice has virtually eliminated the holistic approach and pushed medicine into ICD9/10 codes, (currently going from about 14,000 codes to nearly 68,000…in fact, there’s even one, specific code for “injury caused by riding on the back of pig.) It all becomes a matter of diagnosis of disorders leading to the prescription of drugs. The U.S. is spending $308 billion a year on pharmaceuticals, which is one half of the expenditures of the rest of the entire world in drug purchases. We’re spending about $14.6 billion on anti-psychotic drugs and $10 billion on antidepressants, alone.

The $2.5 trillion that we are spending on healthcare in the United States is NOT allowing us to live longer than other countries, and the really sad news is that most of these expenditures are for preventable diseases. About 90 percent of our expenditures are because of stress related issues, and when we take such amazing statistics into consideration as the fact that the United States consumes two times more fat than Asia, three times less fiber, and 90 percent more animal protein, it has to make us think a little bit about this course that we are currently pursuing.

If you study the statistics, you’ll see that China consumes less red wine than us…but their population lives longer. Japan consumes less fat than we do, and their population lives longer. Italians consume much more red wine than we do, and they live longer. Germans do everything wrong, i.e., eat high fat, drink lots of beer, eat sausages and fats and even they live longer than Americans. What must our conclusion be? Maybe living in the United States is the problem? (Just kidding . . . but maybe it is the fact that we are so intensely committed to a more-is-better philosophy.)

As a population we eat about 50 tons of food in our lifetime. In fact, it’s probably been closer to 51 tons for some of us, and, for the most part, we’re eating lots of chemicals, insecticides and antibiotics in our unnatural and subsidized corn fed animals, and farm raised fish.

Where am I going with all of this? Have you ever been around a really cocky kid who acts like he or she is invincible? That’s why our highest death rates in the teenage years are primarily related to automobile accidents with Caucasian teens and guns with many of the ethnic teens. They truly believe that they are invincible.

It’s always been interesting to me that those people who have been fortunate enough to have lived charmed lives with no sickness and no close relatives or friends who have died have a certain air of immortality that surrounds them. They are lulled into the belief that they will beat the odds and live forever. We are, in fact, on a finite journey that requires us to provide some self-nurturing, lots of personal lifestyle education and a willingness to try to do what is best for our long term quality of life issues the majority of the time.

The bottom line? as my blogger friend, Paul Levy says in his most recent blog post, we are dealing with “temporary immortality.” So, live every day as if it is your last and take better care of yourself.

It was 1991 when one of my professors at Carnegie Mellon University began discussing health policy in the United States. He told us about Arizona, where the state government had decided to stop paying for transplants. Then he went on to explain that desperate families were moving from Arizona to Pittsburgh, just so they could establish residency in Pennsylvania, and their loved one could receive a transplant.

At around that same time, an outspoken politician from Colorado, former Governor Richard Lamm, who ran for President of the United States on the Reform Party, described the travesty of Medicare vs. Medicaid. He described the older generation as committing “generational murder” because, even though many times there was no hope for their survival, for extending their life or for having any quality to their life, we, as a nation, spend 60% of our Medicare dollars on the last 30 or so days of life. He advocated being honest and allowing people to decide if they wanted palliative care.

What he also pointed out was that, as a country, we continue to have one of the highest infant mortality rates in the industrial world. The reason, he theorized, was because the seniors voted and the young mothers didn’t and no politician would dare vote against that senior coalition. (This is not about death panels, it is about honesty in healthcare. It is about transparency and explaining the facts to the families so that they could make rational decisions.) None of his words were well received, but nevertheless, they were filled with candor and embraced very difficult ethical views.

The bottom line? It is a very sad situation when we have to, in effect, sentence people to death at any age because resources are not available to save them, but this is emphatically not about rationing of care, because rationing infers giving everyone a little less. This is about making a government decision to take away everything. So, this is about making rational resource allocation, not based upon the number of votes needed to get re-elected, but based on the value of a life at any and all ages.

Finally, the elephant in the room? Those people killed and wounded in Arizona were killed and wounded because of a man who is most likely mentally ill. We, as a country, must begin to address this mental health issue with parity, with commitment and without judgment. No family is without some member who is suffering from some mental health issue, but this discussion is still ignored, hidden or buried.

So, when the pundits ask if it is about the rhetoric? We don’t know. When they ask if it is about the availability of weapons and ammunition? The answer seems to fall under that same category. BUT, when the question is properly directed toward mental health? The answer seems to be absolutely, yes without a doubt.

During this time of reflection, let’s get serious about the very real and very big challenges that this nation faces. We must, as a nation, take these challenges head-on and deal with “problem solving,” and if this Congress does not begin to take action and begin to solve problems, then we must vote again in May and November to continue to make our voices heard.

Unless we can begin to talk with each other with dignity and respect, we will not make progress. Until we begin to respect the other person’s point of view and understand that debates are healthy again, we will not make progress. Our leaders need to debate, but at the end of that debate, it is essential that they walk out of the room together and agree that they are all here to do a job, and that job is to solve problems.

My heart goes out to all of those families who were impacted by this awful tragedy.

Popular Science in their March 2010 Edition published an article entitled “Waking Up the Brain Dead.” the sub-title read “A Cocktail of Therapies Jump-Starts Patients’ Brains.” Then, the May 2010 Ladies Home Journal is publishing an article entitled, “World Leaders in Translational Clinical Research for Alzheimer’s Disease,” (The International Brain Research Foundation – IBRF; in November of 2009, The Clinical Neuropsychologistpublished an article “The New Neuroscience Frontier: Promoting Neuroplasticity and Brain Repair in Traumatic Brain Injury” that was co-authored by at least two members of the IBRF, Dr. Philip DeFina and his associate Dr. Rosemarie Scolaro Moser, regarding the future of treatment for Traumatic Brain Injury (TBI).

With an 84% success rate in waking up patients from deep, irreversible, persistent vegetative state comas traditional neurologists, neurosurgeons, and neuroscientists have called these “wake ups” flukes, but once you have nearly 45 flukes, the question becomes, “Are they real?” As the Popular Science article states, Dr. DeFina and his team apply already approved medications, electrical stimulation, and nutraceuticals to the patient, but they do it in a virtual cocktail that has had a dramatic impact on these patients.

After having spent several days working with the folks at the International Brain Research Foundation, my personal heart strings began making their own music. Not unlike the work that we did at my previous employer, DeFina’s Research Foundation is blazing new trails, not necessarily by inventing all new methodologies, but by applying new approaches to well-established and FDA-approved drugs and protocols. They are making unbelievable progress with highly nuanced protocols that will potentially change neuroscience forever.

In typical “small science” fashion, the traditional approach to these patients has been to apply one protocol at a time, and when that fails, move on to the next. Dr. DeFina appropriately points out that this unconventional approach is effective because it goes to the source of numerous highly complex brain centers. He asked me to imagine the Wright brothers trying to fly an airplane one “part” at a time. “Orville, do you think this propeller will fly?” Of course, that concept is absurd, but that is an appropriate description of how Traumatic Brain Injuries are currently addressed.

Nearly a dozen years ago, when we were beginning our work at the research institute, it was obvious that the reason that cancer had not been cured was because science takes a very laser-like approach to everything; let’s call it small science. When we determined that we should have a pristine, highly-annotated collection of specially-collected breast tissue, that we should have a central data repository, and that, heaven forbid, we should have ensemble-type multi-disciplinary teams of scientists and MDs working together, it was as if we had suggested that all science be trashed. It was so controversial. To think that one scientist did not keep total and complete control over all of the data generated by his work. It was heresy.

Bottom line? I believe that the International Brain Research Foundation will have us rethinking our living wills not to many years from now as they continue to awaken deep, irreversible coma victims and help them find their lives again. Not unlike the activities at the Windber Research Institute, where the “Platinum Quality Tissue” is currently being used to map the breast genome. We are looking into the future of science, and it is very exciting indeed.

The very difficult news is that the IBRF is totally and completely dependent upon donations and grants for their work, and traditional granting organizations do not favor nontraditional approaches to curing disease and saving lives. So, after you do your due diligence, if you are as moved as I was, check out the IBRF’s website (including their excellent videos) at www.ibrfinc.org, and help them change history.

Why Healing Hospitals? Transparency. Human Dignity. Patient Advocacy. All of these represent a new way of administering health care in this country. Our industrialized model of care in the mirror image of factory-like settings is no longer acceptable, viable, or an alternative. We, as a country, as a society –as a culture, need to step up and do what is right. Love, kindness, nurturing, and a commitment to patient advocacy are the correct ways to interact with our patients.

Many organizations who embrace the various human dignity monikers such as Planetree and Eden Alternative do so for marketing clout, for positive press, or for hoped-for financial gains. Upon meeting some of these leaders, transparency becomes a very recognizable trait because they themselves are transparent –and not in the good sense. Rather, they are transparently “takers” in an environment that is much better served by “givers.”

For a country that is so obsessed with standardized tests, our healthcare delivery scores are abysmal, astonishing, and asinine. Not unlike our appetite for Biggie fast food meals and Biggie drinks, our appetite for beautiful trappings without substance, for corporate jets, for the power of millions and in some cases billions of dollars in reserves has resulted in a dysfunctional health delivery system that looks at patients as widgets.

Nicholas D. Kristof NYT photo

Nicholas Kristof, New York Times Op-Ed columnist has written another compelling article about the U.S. health system, in which he quotes the latest World Health Organization figures. (Download the .pdf file.)According to the WHO report, the United States ranks 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the U.S. is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland. He then quoted another study, a recent report by the Robert Wood Johnson Foundation and the Urban Institute that looked at how well 19 developed countries succeeded in avoiding “preventable deaths,” such as those where a disease could be cured or forestalled. The U.S. ranked in last place. Dead last.

He did find one health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare, he writes. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

Learning how to convert your hospital to the standards of Healing Hospitals is not rocket science. It is, however, not without tough decisions, aggressive doses of nonconformity, a passion and commitment to patient advocacy, and a strong desire to improve infection, readmission, restraint, and mortality rates. It can be done, but it takes guts, a break from the conventional, unconventional wisdom, and a willingness to do what is not only right …but also what is very, very smart.

There were some very bright people involved who confirmed my suspicions, but it was my persistence, my explorations, and my perseverance that took me to those scientists, doctors, and pharmacists. You see, the prognosis that I was given involved a very much dreaded series of events that played heavily in the death of my paternal grandmother – kidney failure. Okay, it was mild. Yes, it was just the very beginning stages, but, like surgery, when it involves my body, it’s major!

After an E-mail to a very well known and highly respected physician at one of the mostly widely recognized medical facilities in the world, my suspicions were even more intensified. Phone calls to two different pharmacist friends resulted in me getting the information that I had been seeking. There were at least three recent studies that confirmed that ARB’s (Angiotensin Receptor Blockers) could cause renal (i.e. kidney) dysfunction, resulting in the doubling of serium creatinine, leading to death.

“Reports in the medical literature reinforce the importance of recognizing that angiotensin-converting enzyme inhibitors should be used with caution in patients with bilateral renal artery stenosis . . . Clinicians should be aware that renal failure might occur when using ARBs in these patients”…

…read one website. Like I said, I’m not a doctor, and I’m sure that there will be plenty of opinions about these studies.

From another website:

“Chicago, IL – The addition of an angiotensin receptor blocker (ARB) to ACE-inhibitor therapy makes treatment noncompliance due to side effects more likely and ups the risks of symptomatic hypotension and renal dysfunction, suggests a pooled analysis of four randomized trials [1]. The findings are consistent with current treatment guidelines that express reservations about routinely combining the two drug classes, the authors write in the October 8, 2007 issue of the Archives of Internal Medicine.“

Well, to add insult to injury, last year I had my upper and lower GI work up, just for old times’ sake. At the end of that procedure, the doc suggested one of those purple pills. Tonight on the news, right after the GM bankruptcy, the story went something like this: According to the Associated Press…

“Taking such popular heartburn drugs as Nexium, Prevacid, or Prilosec for a year or more can raise the risk of a broken hip markedly in people over 50, a large study in Britain found.”

Well, okay, it was Britain. We all know that they are generally much more healthy than we Americans. Maybe the study should have read: “If you are healthy, you will break your hip in England.”

I know, I know. We all have to die of something, but darn it, why does it have to be the result of stuff that is supposed to be helping us stay alive? I hate the thought of spending the equivalent of a Mercedes car payment each month to load my body up with chemicals that do more damage than Jack and Coke or Goose and Tonic. Seriously, Aunt Martha really seemed to have it together: Don’t take anything stronger than an aspirin. For heaven sakes, don’t get a physical if you can avoid it, and live your life in moderation. She’s still going strong in her eighties.

Let me open this blog with a little housekeeping chore. Because I’ve retired from being a hospital president (Yes, they replaced me with two great people, count ‘em, two.) , I’d like to change the name of this thing. It’s not that I’ve established a P-Diddy-type Twitter following where 100,000 human beings are waiting with baited breath to see what my next move will be, it just doesn’t seem right to keep calling myself a hospital president. We know who reads this thing, and we are grateful to our loyal, talented, and brilliant followers. We also know that we can link the old blog names to get you here. So, regardless of what you typed, or what gets Googled, our genius social media maven & webmaster, Michael Russell, can help to bring you home to this site.

Okay, so as a transformational advisor, a broker of sorts, most people with whom we have consulted have described me as a person who can fix things that are broken before they actually break. Maybe we should call it the “Break it if it’s not already fixed” blog. I’d love it if it was a name that would generate millions of hits and companies would fight to advertise on it.

My first thought was to usenickjacobs in the title because there is a Nick Jacobs on Facebook who teaches Aboriginal people in Australia, and he seems popular. There is another Nick Jacobs who is a professional organist, and one who is an athlete. There’s a Nick Jacobs who is a consultant and another a paramedic in London, one who had a blog who is a yachtsman, there’s my son, the commercial real estate broker, and finally, there’s a Nick Jacobs who does pornographic movies who is not my son. Actually, that Nick Jacobs’ followers would probably be the most disappointed by this blog.

Since the .com version of nick jacobs was already taken by some guy in England, we captured nickjacobs.org, and that will work for right now.

If you have any ideas, however, that you think would really rock the blogspere, let us know and we’ll check with our domain registrar to see if it is available. In fact, if you are the winner of a Name Nick’s Blog Contest, I’d be happy to consult for free BY PHONE for at least one hour of brainstorming with you about the topic of your choice: music, healthcare, proteomics, teaching, PR/Marketing, the travel business, or even physician recruitment.

Remember, Hospital Impact is already taken, and, because my last three consulting jobs have been with a newspaper, a nonprofit arts oragnization, and a chain of hotels, we don’t want to think too restrictively. Gotta earn a little money, too.

When we ran the breast center, we found that the website got more hits than anyone could imagine. The problem was that the readers were mostly thirteen-year-old boys who probably weren’t too interested in running a hospital. After Miss America had visited us, the hits went up exponentially when those two searches were combined. Somehow, I don’t think that Nick Jacobs’ Breast Center for Miss America would probably get me the type of following I’m currently hoping to attract. On the other hand?

A very good friend recently asked me to write a brief bio about what my new life is like, and it struck me that it is very much like my old life but without any restrictions. This is what I wrote:

While teaching junior high school instrumental music in the early 1970’s, Nick Jacobs made an extraordinary discovery. He learned that, by empowering his students and surrounding them with positive influences, he no longer was providing a service or even an experience for them.

What this entirely unique teaching style resulted in was a method for helping to transform students. By providing with both passion and commitment the tools needed by them to undertake their journey, his involvement with the students became a means of dramatically helping them to make whatever positive life changes they were seeking.

It was during that early period in his career that he also discovered that this formula could work to positively change lives in almost any aspect of living as he ran an arts organization, a convention bureau, and finally a hospital and research institute.

Since that time he has dedicated his personal work to helping others make their lives better, and that is exactly what he is doing in his position as an international executive consultant with SunStone Consulting, LLC.

Maybe that will give you something to chew on? Okay, something on which to chew.

SunStone Consulting. With more than 20 years experience in executive hospital leadership, Nick has an acknowledged reputation for innovation and patient-centered care approaches to health and healing.

Several dozen bloggers in the health care field and beyond are today engaged in a blog rally*, simultaneously posting the item below to encourage conversation about a topic that’s often avoided but needs to be addressed in every family: How we want to die. I’ve written about this before, with regard to my mother. Please try it, using the slide above as a discussion guide. It’s not that hard to have the conversation with your loved ones once you get started.

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We make choices throughout our lives – where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide (that’s it above) and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us – and the people we care for – can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

Sharon Begley wrote for Newsweek Magazine an article entitled Where Are the Cures? Scientists call the gulf between a biomedical discovery and new treatment the “valley of death.” This has been a topic about which I have written several times. As a relative newcomer to the world of scientific research, my journey has been somewhat perplexing and always disconcerting. Every day articles, web stories, and scientific papers cross my desk touting the amazing discoveries that are being made at the basic research level. When I query my insiders, however, they point out that these discoveries very rarely ever get to the public for their care and treatment.

Some of the reasons behind this gap in medical science lead back to a broken system with inappropriate incentives locked firmly into place. How do we get the basic discoveries to be translated and moved into actual treatments?

Why are so few of the discoveries making their way to both treatments and cures? It is because our system of NIH-sponsored science is set up to discover things; plain and simple. Once the discovery is made, articles can be written, which is the sought after reward in academia since these publications lead to more grants from the NIH, and so the circle goes round and round.

Image Credit: Corbis

The obstacles to translational research in which the studies actually move from the scientist’s bench to the patient’s bedside are so intense that they are referred to in some areas of the scientific community as the “valley of death.” According to Begley’s article, “The valley of death is why many promising discoveries-genes linked to cancer and Parkinson’s disease; biochemical pathways that ravage neurons in Lou Gehrig’s disease-never move forward.”

The author challenges the incoming Obama administration and Congress to take a look at this daunting dilemma and to begin to revamp our biomedical research system by creating what Richard Boxer, a urologist at the University of Miami, and Lou Weisbach, a Chicago entrepreneur, call a “Center for Cures” at the NIH. Interestingly enough, the model that they endorse is exactly what was created here in Windber where multidisciplinary teams of biologists, proteomic and genomic scientists, technicians, and biomedical informatics specialists work together with Walter Reed Army Medical Center to move a discovery to an actual cure.

Of course, with the cuts made to the NIH funds, creating anything new that is unfunded could take away from basic research, and limit hopes for these cure discoveries. The article explains that while the NIH budget was doubling, new drug approvals fell from 53 in 1996 to 18 in 2006. What’s wrong with this picture? Twice the money, less than half the discoveries.

The sad case, however, is that even those organizations that try to establish these new world order cure centers are not funded by the NIH because of this fundamental design to enhance only basic research. The article ends with this: “I’d be willing to put up with potholes in exchange for a new administration spending serious money to take the discoveries taxpayers have paid for and turn them into cures.”

Yesterday afternoon the realities of humanism, mortality, and fear attempted to take me out for about the one millionth time in my life. A phone call came from a loved one casually explaining that the doctor had potentially discovered a problem that needed further examination. When the office called for an appointment to have the scan done, they were told that it would be approximately a week before there was an opening in the schedule.

As an insider, I knew that a certain number of slots were held each day for emergency or unscheduled procedures. Not unlike the hotel that holds back a room or two from the 1-800 reservation list, just in case a preferred guest or luminary comes through the doors, flexibility is something that hospitals have to embrace at some level.

Once again, as an insider, a call to the department resulted in an immediate invitation to come in for the test the very next day.

F. Nicholas “Nick” Jacobs, FACHE, is the international director for SunStone Consulting, LLC. In that capacity he provides transformative, strategic solutions to companies, organizations and individuals. He has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Throughout his career, Mr. Jacobs has developed a reputation for innovative leadership that focuses on effective delivery of service that puts the patient’s needs and concerns first. He speaks extensively on this topic and has spoken for the American College of Healthcare Executives, American Hospital Association, and the World Health Organization numerous times.